DR. HOOK- Losing it: Obesity promises diabetes epidemic

Eating habits are very interesting. Some people don't let food on their plate touch–– so much for peanut butter and jelly sandwiches. Some people won't eat meat if the bone is still attached–– so much for T-bone steaks. I know some who graze like Elsie the cow but won't sit down for dinner with the rest of the herd. (By the way, how do cows great each other? With a hand shake or a milk shake?)

I used to be a very slow and finicky eater. I probably ate less than Calista Flockhart and Skinny-Girl on Survivor. Call me Morris the Cat. I don't think I ever finished a hot meal as a child. Oooh, my parents used to get sooooo mad at me.

"You will finish your meal. Do you know how many people are starving in this world? When we were in the war...." But if you gave me a banana split, it was gone in a split second.

Everything changed for me as a medical resident. You never knew if you were going to be able to finish your meal while on call, so I learned to inhale my food. Yes, I inhaled, Mr. Clinton. The problem is that I still inhale my food like a dolphin. So what would happen if I ate slower again?

Certain diabetic medications now do slow down the GI tract, which makes food last longer in the stomach. Slowing down the GI tract helps people "fill up" quicker, which causes them to eat less. Also slowing down the GI tract decreases the sugar rush from the GI tract into the blood stream, and for diabetics this is a very healthy thing.

Byetta has been on the market a few years, which is an analog of incretins— gut hormones that stimulate the pancreas to secrete insulin (which lowers blood sugars), inhibits the pancreas from secreting glucagon (a hormone that raises blood sugars), slows the GI system down, and increases satiety. Byetta is an incretin analog that requires two injections a day. (More information on Byetta available at DrJohnHong.com)

Januvia is the newest kid on the block to treat Type II Diabetes. It's a pill that's taken orally once a day to allow incretins to rock & roll. What I'm going to type right now might look like "blah blah blah," but stick with me a second. DDP-4 (dipeptidyl peptidase-4) "eats up" incretins in the gut. So to keep the incretins levels up, a DDP-4 inhibitor (Januvia) was made. (Where do pharmaceutical companies come up with these names? To me Januvia sounds like a foreign word for January.)

The studies published on Januvia appear to be pretty good. Compared to traditional oral diabetic medications like the sulfonylurea glipizide, it lowers blood sugars just as well with fewer instances of hypoglycemia (low blood sugars). Also, Januvia doesn't cause weight gain as sulfonylureas do. As obesity is the underlying problem in Type II diabetes, why add fuel to the fire?

Two-thirds of American adults are overweight or obese, and over 20 million Americans have diabetes. Fifty-four million Americans have glucose intolerance (pre-diabetes), so can you say, "Hindenburg"?

There's gong to be an explosion of diabetes in this country in the next few decades if Americans don't start losing weight. Diabetes costs this country about $132 billion a year.

Yet there are quite a few diabetics and pre-diabetics who say, "Eh, can I take my Januvia with a cheeseburger, non-diet soda, and banana split while sitting on the couch for 12 hours to watch athletes run up and down the field?"

Dr. Hook cracks a joke or two, but he's a renowned physician with a local practice. Email him with your questions.